ENS 2013 (Barcelona, Spain)
Monday June 10, 2013
OBJECTIVE:
To describe patient-reported response of pseudobulbar affect
(PBA) secondary to stroke and Alzheimer’s disease (AD) to oral twice daily
fixed dose combination of dextromethorphan 20 mg and quinidine 10 mg (DM/Q).
METHODS: Retrospective chart review at a single neurology clinic of
13 patients with AD (9 men, 4 women) and 17 patients with stroke (7 men, 10
women).
RESULTS:
All 13 patients with AD and PBA who were treated with DM/Q
reported an improvement in their PBA frequency and/or severity, with 8 patients
rating it as “mild” and 5 rating it as “major.” One patient discontinued therapy
after 5 months due to financial concerns. Mean age at time of diagnosis with AD
was 59 years (median = 58 years) and the length of time from AD diagnosis to
PBA onset was 12 months (range=1–26). Prior to initiating DM/Q, the mean number
of weekly PBA episodes was 19 (median=17), which were rated as mild by 2
patients, moderate by 5 patients and severe by 6 patients. Mean lag from PBA
onset to DM/Q initiation was 17 months (median=8, range=1–53).
Most of the 17 patients with stroke and PBA who were treated
with DM/Q reported an improvement in their PBA frequency and/or severity, with
3 patients rating it as “mild” and 10 rating it as “major.” Four patients
discontinued DM/Q due to no reported change (all of those without an
improvement had mild PBA). Mean and median age at time of diagnosis with stroke
was 57 years, and the length of time from stroke diagnosis to PBA onset was 10
months (range=1–24). Prior to initiating DM/Q, the mean number of weekly PBA
episodes was 14 (median=10), which were rated as mild by 7 patients, moderate
by 7 patients and severe by 10 patients. Mean lag from PBA onset to DM/Q
initiation was 21 months (median = 9 months, range = 1 – 84 months).
CONCLUSIONS:
This real-word case series confirms the efficacy of DM/Q in
the treatment of PBA regardless of underlying neurologic condition. DM/Q has
previously been demonstrated to be safe and effective in the treatment of PBA
secondary to multiple sclerosis and amyotrophic lateral sclerosis. In 2010, the
U.S. Food and Drug Administration approved DM/Q for PBA regardless of the
underlying neurologic condition due to the “clear distinctness of the primary
pathology” of both of the conditions studied. Ongoing controlled studies in special populations, in
addition to real-world case series suggest the appropriateness of using DM/Q in
the treatment of PBA regardless of the underlying neurologic condition.
- Dr. Daniel Kantor, MD
Medical Director
Neurologique
info@neurologique.org
www.neurologique.org
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